| NPI | 1265940449 |
|---|---|
| Former Name | CRYSTAL LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2023-10-19 |